AimThe TRANSFORM‐HF trial demonstrated no significant outcome differences between torsemide and furosemide following hospitalization for heart failure (HF), but may have been impacted by non‐adherence to the randomized diuretic. The current study sought to determine the treatment effect of torsemide versus furosemide using an on‐treatment analysis inclusive of all randomized patients except those confirmed non‐adherent to study diuretic.Methods and resultsTRANSFORM‐HF was an open‐label, pragmatic randomized trial of 2859 patients hospitalized for HF from June 2018 through March 2022. Patients were randomized to a loop diuretic strategy of torsemide versus furosemide with investigator‐selected dosage. This post‐hoc on‐treatment analysis included all patients alive with either known or unknown diuretic status, and excluded patients confirmed to be non‐adherent to study diuretic. This modified on‐treatment definition was applied separately at time of hospital discharge and 30‐day follow‐up. All‐cause mortality and hospitalization outcomes were assessed over 12 months. Overall, 2570 (89.9%) and 2374 (83.0%) patients were included in on‐treatment analyses at discharge and 30‐day follow‐up, respectively. There was no significant difference in all‐cause mortality between torsemide and furosemide in patients on‐treatment at discharge (17.5% vs. 17.8%; hazard ratio [HR] 1.01 [95% confidence interval [CI] 0.83–1.22], p = 0.96) and at 30‐day follow‐up (14.5% vs. 15.0%; HR 1.02 [95% CI 0.81–1.27], p = 0.90). All‐cause mortality or all‐cause hospitalization was similar between torsemide and furosemide in patients who were on‐treatment at discharge (58.3% vs. 61.3%; HR 0.92 [95% CI 0.82–1.03]) and 30‐day follow‐up (60.9% vs. 64.4%; HR 0.93 [95% CI 0.82–1.05]). In patients who were on‐treatment at 30‐day follow‐up, there were 677 total hospitalizations in the torsemide group and 686 total hospitalizations in the furosemide group (rate ratio 0.99 [95% CI 0.86–1.14], p = 0.87).ConclusionsIn TRANSFORM‐HF, a post‐hoc on‐treatment analysis did not meaningfully differ from the original trial results. Among those deemed compliant with the assigned diuretic, there remained no significant difference in mortality or hospitalization after HF hospitalization with a strategy of torsemide versus furosemide.Clinical Trail Registration: ClinicalTrials.gov Identifier: NCT03296813.

中文翻译：

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托拉塞米与呋塞米对因心力衰竭住院患者的治疗分析：TRANSFORM-HF 的事后分析


目的 TRANSFORM-HF 试验表明，因心力衰竭 (HF) 住院后，托拉塞米和呋塞米之间没有显着的结果差异，但可能受到不坚持随机利尿剂的影响。当前的研究旨在通过治疗分析确定托拉塞米与呋塞米的治疗效果，该分析包括所有随机患者（确认不坚持使用研究利尿剂的患者除外）。 方法和结果 TRANSFORM-HF 是一项开放标签、实用性随机试验，纳入了 2859 名患者2018 年 6 月至 2022 年 3 月期间因心力衰竭住院的患者。患者被随机分配接受托拉塞米与呋塞米袢利尿策略，剂量由研究者选择。这项事后治疗分析包括所有已知或未知利尿状态的存活患者，并排除了确认不坚持研究利尿剂的患者。这一修改后的治疗定义在出院时和 30 天随访时分别应用。对 12 个月内的全因死亡率和住院结果进行了评估。总体而言，出院时和 30 天随访时的治疗分析分别纳入了 2570 名 (89.9%) 和 2374 名 (83.0%) 患者。出院时接受治疗的患者托拉塞米和呋塞米的全因死亡率没有显着差异（17.5% vs. 17.8%；风险比 [HR] 1.01 [95% 置信区间 [CI] 0.83–1.22]，p = 0.96）和 30 天随访时（14.5% vs. 15.0%；HR 1.02 [95% CI 0.81–1.27]，p = 0.90）。在出院时接受治疗的患者中，托拉塞米和呋塞米的全因死亡率或全因住院率相似（58.3% vs. 61.3%；HR 0.92 [95% CI 0.82–1.03]）和 30 天随访（60.9% 与 64.4%；HR 0.93 [95% CI 0.82–1.05]）。 在 30 天随访时接受治疗的患者中，托拉塞米组总共有 677 例住院患者，呋塞米组总共有 686 例住院患者（率比 0.99 [95% CI 0.86-1.14]，p = 0.87）。结论在 TRANSFORM-HF 中，事后治疗分析与原始试验结果没有显着差异。在那些被认为符合指定利尿剂的患者中，使用托拉塞米与呋塞米策略治疗心衰住院后，死亡率或住院率没有显着差异。临床试验注册：ClinicalTrials.gov 标识符：NCT03296813。